Emergency Department

Questionnaire

What is the survey about?

This survey is about your most recent visit to the Emergency Department (may be known as A&EorCasualty) at the National Health Service hospital named in the letter enclosed with this questionnaire.

Who should complete the questionnaire?

The questions should be answered by the person named on the front of the envelope. If that person needs help to complete the questionnaire, the answers should be given from his/her point of view – not the point of view of the person who is helping.

Completing the questionnaire

For most questions, please tick clearly inside one box using a black or blue pen. For some questions you will be instructed that you may tick more than one box.

Sometimes you will find the box you have ticked has an instruction to go to another question. By following the instructions carefully you will miss out questions that do not apply to you.

Don’t worry if you make a mistake; simply cross out the mistake and put a tick in the correct box.

Please do not write your name or address anywhere on the questionnaire.

Questions or help?

If you have any questions, please call the helpline number given in the letter enclosed with this questionnaire.

Taking part in this survey is voluntary.

Your answers will be treated in confidence

Emergency DepartmentScored Questionnaire 2008. 28/02/2008. Version 3 Page 1

Emergency Department Scored Questionnaire 2008. 28/02/2008.Version 3 Page 1

Please remember, this questionnaire is about your most recent visit to the Emergency Department (A&E) of the NHS Trust named in the accompanying letter.

Arrival at the Emergency Department

1.What was the MAIN reason that you went to the Emergency Department for?(Tick one only)

1I was told to go to an Emergency Department by a health professional (e.g. GP, nurse, NHS Direct)

2I was taken to the Emergency Department by the Ambulance Service

3My GP was not available or my local health centre was closed

4I was not aware of any other service available at the time

5I wanted a second opinion

6I decided that I needed to go to an Emergency Department

7Somebody else (e.g. friend, relative, colleague) decided that I needed to go to an Emergency Department

2.How did you travel to the hospital?

1By car Go to3

2In an ambulance Go to4

3 By taxi Go to6

4 On foot Go to6

5 On public transport Go to6

6 Other Go to6

3.Was it possible tofind a convenient place to park in the hospital car park?

100 1Yes Go to6

0 2No Go to6

-3I did not need to find a place to park Go to6

-4Don’t know Go to 6

Travelling by ambulance

4.Did the ambulance crew explain your care and treatment in a way you could understand?

100 1Yes, definitely

50 2Yes, to some extent

0 3No

-4Don’t know / Can’t remember

5.Overall, how would you rate the care you received from the ambulance service?

100 1 Excellent

80 2Very good

60 3Good

40 4Fair

20 5Poor

0 6 Very poor

Reception

6.Were you given enough privacy when discussing your condition with the receptionist?

100 1 Yes, definitely

50 2Yes, to some extent

0 3 No

- 4I did not discuss my condition with a receptionist

Waiting

7.How long did you wait before you firstspoke to a nurse or doctor?

100 1 0 -15 minutes

672 16 - 30 minutes

333 31- 60 minutes

0 4 More than 60 minutes

-5Don’t know/ Can’t remember

8.From the time you first arrived at the Emergency Department, how long did you wait before being examined by a doctorornurse?

100 1 I did not have to wait Go to10

80 21-30 minutes Go to 9

60 331-60 minutes Go to 9

40 4More than 1 hour but no more than 2 hours Go to 9

20 5More than 2 hours but no more than 4 hours Go to 9

0 6More than 4 hours Go to 9

-7Can’t remember  Go to 9

-8I did not see a doctor or a nurse Go to 10

9.Were you told how long you would have to wait to be examined?

100 1Yes, but the wait was shorter

100 2Yes, and I had to wait about as long as I was told

50 3Yes, but the wait was longer

0 4No, I was not told

-5Don’t know/ Can’t remember

10.Overall, how long did your visit to the Emergency Department last?

100 1 Up to 1 hour

832 More than 1 hour but no more than 2 hours

673 More than 2 hours but no more than 4 hours

504 More than 4 hours but no more than 8 hours

335More than 8 hours but no more than 12 hours

176More than 12 hours but no more than 24 hours

07 More than 24 hours

-8Can’t remember

Doctors and nurses

11.Did you have enough time to discuss your health or medical problem with the doctor or nurse?

100 1 Yes, definitely Go to12

50 2 Yes, to some extent Go to12

0 3 NoGo to12

-4 I did not see a doctor or a nurseGo to 17

12.While you were in the Emergency Department, did adoctor or nurse explain your condition and treatment in a way you could understand?

100 1 Yes, completely

50 2Yes, to some extent

0 3 No

-4 I did not need an explanation

13.Did the doctors and nurses listen to what you had to say?

100 1 Yes, definitely

50 2 Yes, to some extent

0 3 No

14.If you had any anxieties or fears about your condition or treatment, did a doctoror nurse discuss them with you?

100 1 Yes, completely

50 2 Yes, to some extent

0 3 No

-4 I did not have anxieties or fears

15.Did you have confidence and trust in the doctors and nurses examining and treating you?

100 1 Yes, definitely

50 2 Yes, to some extent

0 3 No

16.Did doctors or nurses talk in front of you as if you weren’t there?

01 Yes, definitely

50 2 Yes, to some extent

100 3 No

your care and treatment

17.While you were in the Emergency Department, how much information about your condition or treatment was given to you?

50 1 Not enough

100 2 Right amount

50 3 Too much

0 4I was not given any information about my condition ortreatment

18.Were you given enough privacy when being examined or treated?

100 1 Yes, definitely

50 2Yes, to some extent

0 3 No

19.If you needed attention, were you able to get a member of staff to help you?

100 1 Yes, always

50 2 Yes, sometimes

0 3 No, I could not find a member of staff to help me

1004 A member of staff was with me all the time

-5 I did not need attention

20.Sometimes in a hospital, a member of staff will sayone thing and another will say something quite different. Did this happen to you in the Emergency Department?

0 1 Yes, definitely

50 2 Yes, to some extent

100 3 No

21.Were you involved as much as you wanted to be in decisions about your care and treatment?

100 1 Yes, definitely

50 2Yes, to some extent

0 3 No

-4 I was not well enough to be involved in decisions about my care

Tests

22.Did you have any tests (such as x-rays, scans or blood tests) when you visited the Emergency Department?

1 Yes Go to23

2 No Go to24

23.Did a member of staff explain the results of the testsin a way you could understand?

100 1 Yes, definitely

50 2 Yes, to some extent

0 3 No

-4 Not sure / Can’t remember

-5 I was told that the results of the tests would be given to me at a later date

0 6I was never told the results of the tests

Pain

24.Were you in any pain while you were in the Emergency Department?

1 Yes Go to25

2 No Go to28

25.Did you request pain relief medication?

1 Yes  Go to26

2 No  Go to 27

3I was offeredor givenpain relief medication without asking Go to 27

26.How many minutes after you requested pain relief medicationdid it take before you got it?

100 1 0 minutes/right away

832 1 - 5 minutes

673 6 - 10 minutes

50 4 11 - 15 minutes

33 5 16 - 30 minutes

176 More than 30 minutes

0 7 I asked for pain reliefmedication but wasn’t given any

27.Do you think the hospital staff did everything they could to help control your pain?

100 1 Yes, definitely

50 2 Yes, to some extent

0 3 No

- 4 Can’t say/ Don’t know

Hospital environment facilities

28.In your opinion, how clean was the Emergency Department?

100 1 Very clean

672 Fairly clean

333 Not very clean

0 4 Not at all clean

-5 Can’t say

29.How clean were the toilets in the Emergency Department?

100 1 Very clean

672 Fairly clean

333 Not very clean

0 4 Not at all clean

-5 I did not use a toilet

30.While you were in the Emergency Department, did you feel bothered or threatened by other patients?

0 1 Yes, definitely

50 2 Yes, to some extent

100 3 No

Leaving the Emergency Department

31.What happened at the end of your visit to the Emergency Department?

1 I was admitted to the same hospital Go to38

2 I was transferred to a different hospital orto a nursing home Go to 38

3 I went home Go to 32

4 I went to stay with a friend or relative Go to32

5 I went to stay somewhere else Go to32

Medications (e.g. medicines, tablets, ointments)

32.Before you left the Emergency Department, were any new medications prescribed for you?

1 Yes Go to33

2 No Go to35

33.Did a member of staff explain the purpose of the medications you were to take at home in a way you could understand?

100 1 Yes, completely

50 2 Yes, to some extent

0 3 No

- 4 I did not need an explanation

34.Did a member of staff tell you about medication side effects to watch for?

100 1 Yes, completely

50 2 Yes, to some extent

03 No

- 4 I did not need this type of information

Information

35.Did a member of staff tell you when you could resume your usual activities, such as when to go back to work or drive a car?

100 1Yes, definitely

50 2Yes, to some extent

0 3No

- 4I did not need this type of information

36.Did a member of staff tell you about whatdanger signals regarding your illness or treatment to watch for after you went home?

100 1 Yes, completely

50 2 Yes, to some extent

0 3 No

- 4 I did not need this type of information

37.Did hospital staff tell you who to contact if you were worried about your condition or treatment after you left the EmergencyDepartment?

100 1 Yes

0 2 No

-3 Don’t know / Can’t remember

OVERALL

38.Was the main reason you went to the Emergency Department dealt with to your satisfaction?

100 1 Yes, completely

50 2 Yes, to some extent

0 3 No

39.Overall, did you feel you were treated with respect and dignity while you were in the Emergency Department?

100 1 Yes, all of the time

50 2 Yes, some of the time

0 3 No

40.Overall, how would you rate the care you received in the Emergency Department?

100 1 Excellent

80 2 Very good

60 3 Good

40 4 Fair

20 5 Poor

0 6 Very poor

about you

41.Are you male or female?

1 Male

2 Female

42.What was your year of birth?

(Please write in) e.g. / 1 / 9 / 3 / 4
1 / 9

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Your own health state today

By placing a tick in one box in each group below, please indicate which statements best describe your own health state today.

43.Mobility

1I have no problems in walking about

2I have some problems in walking about

3I am confined to bed

44.Self-Care

1I have no problems with self-care

2I have some problems washing or dressing myself

3I am unable to wash or dress myself

45.Usual Activities (e.g. work, study, housework, family or leisure activities)

1I have no problems with performing my usual activities

2I have some problems with performing my usual activities

3I am unable to perform my usual activities

46.Pain/Discomfort

1I have no pain or discomfort

2I have moderate pain or discomfort

3I have extreme pain or discomfort

47.Anxiety/Depression

1I am not anxious or depressed

2I am moderately anxious or depressed

3I am extremely anxious or depressed

48.Do you have any of the following long-standing conditions? (TICK ALL THAT APPLY)

1Deafness or severe hearing impairment Go to49

2Blindness or partially sighted Go to 49

3A long-standing physical condition Go to 49

4A learning disability Go to 49

5A mental health condition  Go to 49

6A long-standing illness, such as cancer, HIV, diabetes, chronic heart disease, or epilepsy  Go to 49

7No, I do not have a long-standing condition Go to 50

49.Does this condition(s) cause you difficulty with any of the following? (TICK ALL THAT APPLY)

1Everyday activities that people your age can usually do

2At work, in education, or training

3Access to buildings, streets, or vehicles

4Readingor writing

5People’s attitudes to you because of your condition

6Communicating, mixing with others, or socialising

7Any other activity

8No difficulty with any of these

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50.
To which of these ethnic groups would you say you belong?(Tick one only)

a. WHITE

1British

2Irish

3Any other White background

(Please write in box)

b. MIXED

4 White and Black Caribbean

5 White and Black African

6 White and Asian

7 Any other Mixed background

(Please write in box)

c. ASIAN OR ASIAN BRITISH

8 Indian

9 Pakistani

10Bangladeshi

11Any other Asian background

(Please write in box)

d. BLACK OR BLACK BRITISH

12 Caribbean

13 African

14 Any other Black background

(Please write in box)

e. CHINESE OR OTHER ETHNIC GROUP

15 Chinese

16 Any other ethnic group

(Please write in box)

ANY OTHER COMMENTS

If there is anything else you would like to tell us about your experiences in the Emergency Department, please do so here.

THANK YOU VERY MUCH FOR YOUR HELP

Please check that you answered all the questions that apply to you.

Please post this questionnaire back in the FREEPOST envelope provided.

No stamp is needed

Emergency Department Scored Questionnaire 2008. 28/02/2008. Version 3 Page 1